"In Defense of Football" - A Commentary

Coach Fore,

Your article In Defense of Football has taken the 1st step and will hopefully be used as a bridge – a way to redirect the focus from contentious debate to proven, actionable safety steps.

We applaud your personal efforts to make football safer by securing ATs for the high schools at which you were employed. We also applaud your personal decision to introduce your oldest son to football “at a young age through non contact.”

“THE GAME HAS NEVER BEEN AS SAFE AS IT IS TODAY.” As you state, rules changes, practice restructuring, and coach education have improved over the last few years.

But we can do better and MUST DO BETTER. In your home state, “there are more than 800,000 high school athletes in the state but California does not require schools to have certified athletic trainers at practices and games.” (Ref)

What if we all turned our attention to asking (with conviction) state legislators to make saving lives the priority by finding a way to provide what we know saves lives – ATs on the sidelines of all youth sports who have an actionable safety system where all stakeholders (ATs, athletes, parents, coaches, and administrators) are connected and work together to provide the safest possible sports environment for our kids?

We know - it is not only football. Look at what happened in a California high school girl’s basketball game: "The video is clear that she hit her head. Ice was put on her head, she was put back into the game and a concussion test was not performed," “Twin Rivers, like many school districts throughout the state, does not provide the funding for a certified athletic trainer at games and practices, which puts coaches in the duel role of both coach and trainer.” (Ref)

As this paper states, “Timely removal from activity after concussion symptoms remains problematic despite heightened awareness….I-RFA [Immediate removal from activity] is a protective factor associated with less severe acute symptoms and shorter recovery after SRC [sports-related concussion].”

The current situation requires that “parents, volunteers and often coaches must take it upon themselves in assessing injuries, concussions, heat stroke, cardiac arrest and more. Some of those require an immediate response.” (Ref) Thus parents and coaches are still placed in the unenviable position of making potentially life and death decisions without adequate training or systems in place.

You discuss the state mandate to remove an athlete for a suspected concussion. Concussion laws mandate removal in SCHOOL SPORTS for all 50 states and D.C. However, in 23 states these laws do NOT cover non-school system sports. You state, “Many states now mandate that a doctor and or ambulance must be at every game.” Many do not and very few require it at all practices. Research tells us, “Football practices were a major source of concussion at all 3 levels [youth, high school, college] of competition.“ (Ref)

Youth Sports

Each state has its own high school sports association and at least on paper there are safety protocols and policies. But the biggest safety goose egg is youth sports – not just football, but all youth sports.

The bulk of youth sports (ages 5 - 14) is played in leagues and clubs – over 30 million kids (just under 8 million play high school sports). Our youth organizations are our least prepared and least protected and these kids are the most vulnerable. This is where we can make a HUGE difference.

We can all agree that everyone on the sidelines and in the stands can become a better observer of the signs of concussions. If a coach can tell, in real time, whether the QB took a 3 or 5 step drop or what pitch the pitcher threw (< 0.5 seconds), we (coaches, parents, admins) can certainly learn to become better observers of the signs of concussions. Yes, the layperson can become an excellent observer as described by Martland some 90 years ago. This is especially important because no matter how much we educate our athletes, in the heat of the game, they are simply not going to admit they are experiencing symptoms. We get it. Look what happened to Robert Back.

What about liability?

A prominent sports attorney stated: these youth sports organizations "can't change the liability by not adopting standards - it's there whether they want it or not. If I'm looking at the case and they don't have any procedures or protocols it's going to make them look worse. They’re going to be bound by what's out there anyway for why didn't they take the time to show they cared and they wanted safety procedures and policies."

Parents, Coaches, Administrators

Does your organization require pre-participation physicals? Few youth sport organizations (football included) require this. So please do not tell us the information in your Emergency 3 ring binder is up to date if the athlete did not have a recent sports physical. And if you are still using a 3-ring binder then you can make a huge upgrade in both accuracy and efficiency.

Do you really know if your athletes need an EpiPen or asthma inhaler? Do you know how to use either one? Research says that over 80% of people with conditions that require one or the other do not!

Parents – have you discussed the needs of your athlete with the coaches? Are you at every PRACTICE too? If not, why not show the coach how to use the EpiPen or inhaler and give them consent to administer it. Admins – do you have the consent documented?

Does the athlete have Sickle Cell trait? Do you know the importance of knowing this? In this high school, this boy died because no one knew and no one knew what to do.

And more on the heat. Look at what happened to Zach Martin. Lewis Simpkins. Jordan McNair. Does your organization have a heat plan in place? Not simply “recommendations,” but a required plan. Read more here and here.

Brain injury. Does the youth sports organization have a robust concussion management system in place? Do you really understand the meaning of concussion “protocol?”

  • Who removes the player if an AT is not present? Parent, coach, referee?

  • Who documents the signs and symptoms (triggers)? What are those signs and symptoms? Does everyone know these? Does the coach/parent have the handy concussion signs & symptoms list in his/her pocket? Really?

  • Who is notified? When and how? Phone, fax, email, SMS, FB message, Skype, Facetime?

  • Where is the doctor’s note?

  • To whom is it given? Where is it stored? How? Please do not say “paper.”

  • Is the doctor familiar with the latest concussion guidelines (Berlin Conference)?

  • What is the date of return? Does the return date mean the return to sport or the return to learn protocol – do you know what these are?

  • Return to Learn/Sport protocol – who monitors each step of the protocol? How is this documented? So many leagues and clubs do not have medical providers, so is every step of this protocol going to be monitored by the child’s physician? A parent? A coach?

  • Does the administrator have full oversight over the concussion protocol to make sure everything is in order (the date, is the note legitimate, the meaning of the date) and the child is not returned to play too soon?

  • Is all of this documented every step of the way?

  • Can the administrator track each stage of the protocol?

  • How is each step during this process communicated? To whom? Is it done in real time?

  • This entire process can now be managed on your phone. That's our commitment to youth sports.

“THE GAME [youth sports] HAS NEVER BEEN AS SAFE AS IT IS TODAY.” Have things improved a bit? Yes. Do we have a LONG way to go? Yes, we do. Let's get started!

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